<p> Beth Israel Deaconess Medical Center BIDMC Manual </p><p>Title: Opt Out </p><p>Policy #: PV-19</p><p>Purpose: To describe the process by which a patient can limit the use and/or disclosure of his/her Protected Health Information (PHI refer to PV-04 Confidentiality) for BIDMC OCHA (refer to PV-01 Beth Israel Deaconess Medical Center Organized Health Care Arrangement) fundraising activities and in the BIDMC hospital patient directory. </p><p>Policy Statement: It is the responsibility of BIDMC OHCA to have a process by which a patient may opt out of uses/disclosures of his/her PHI for the following reasons as described in the BIDMC Notice of Privacy Practices: 1. Fundraising activities 2. Hospital patient directory</p><p>Description: Upon receiving and reviewing the BIDMC OHCA Notice of Privacy Practices, a patient may choose to withdraw permission for fundraising activities and in the hospital patient directory. The person to whom the request is made is responsible for obtaining the request in writing and forwarding the request to the Development Department; or, is responsible for referring the patient to the Privacy Officer who will assist the patient in completing the request.</p><p>The Development Department must keep appropriate record of all patients who have made opt out requests (refer to PV-12 Privacy Practices for Fundraising).</p><p>The BIDMC Admitting Department is responsible for the maintenance of the Hospital Patient Directory and will process requests upon receipt. The patient may indicate his/her desire to opt out by telling his/her primary nurse, physician or Privacy Officer or by contacting the Admitting Department directly. Upon receipt of request, admitting staff will set the privacy flag in the CCC Inpatient Admitting system. This blocks access to patient information via the CCC Patient Look-Up option. It does not prevent access to clinicians caring for the patient or others involved in TPO activities as described in the BIDMC Notice of Privacy Practices. Request to opt out must be made upon each admission.</p><p>Vice President Sponsor: Marsha Maurer, RN, SVP, Clinical Operations</p><p>Approved By: </p><p> Operations Council: </p><p>PV-19 Page 1 of 2  Medical Executive Committee: </p><p>Requestor Name: Leon Goldman, MD Chief Compliance and Privacy Officer Office of Business Conduct </p><p>Original Date Approved: 3/31/03</p><p>Next Review Date: 3/09</p><p>Revised: 04/07/06 </p><p>Eliminated:</p><p>References:</p><p>PV-19 Page 2 of 2</p>